Many articles about diabetes appear daily, many of them very interesting. The intent here is to make some of these available for others who may not see them or have bypassed them. I will try to comment briefly on those I have grouped or on an individual article. This is not guaranteed to be a daily post, but I hope that this will give you ideas for your own research or blog posts. Please talk to your doctor about medical problems.

08 July 2013

Are Doctors Using Meaningful Use with Patients?

This remains to be seen and raises some
red flags for patients. Granted, we will find out in 2014 and
probably not before then. Here are the rules to this point on the
books, but I know from experience they are not being followed in most
cases.

The rules state that physicians are to
engage patients in their care is part of Meaningful Use Stage 2 which
becomes law in 2014, and includes specific requirements that
physicians must adhere to including:

#1. Provide patients with their
health information (via a web portal) on 50% of occasions and have at
least 5% of these patients actually download, view or transmit that
data to a third party.

#2. Provide a summary of the care
record for 50% of transitions of care during referral or transfer of
patient care settings.

#3. Provide patient-specific
education resources identified by Certified EHR technology to more
than 10% of patients with an office visit.

#4. Engage in secure messaging to
communicate with patients on relevant health information.

#5. Make available all imaging
results through certified EHR technology.

#6. Provide clinical summaries to
more than 50% of patients within one business day.

#7. Provide patients for more than
10 percent of all unique patients with office visits

seen by the EP during the EHR
reporting period with patient-specific education resources.

This is very specific and there have
already been attempts to water this down and make it less effective.
It is not the existence of the regulations and their incentives that
are in question, but whether physicians are adapting. Many are not
willing to adapt and are saying that as long as patients remain
passive, they can't change. Others are still concerned about billing
time and especially those working for hospitals must abide by their
employer's wishes. This is not favorable for patients when hospitals
call the shots.

At the same time, many physicians are
beginning to realize that engaging the patient in their health care
decisions will make health care more efficient and cost effective,
and improve patient outcomes. What many physicians are avoiding and
say they will avoid is emails (#4 above). On this, I can agree, as
most of us do not have secure email available to us. Almost all
email services available to us are very insecure and open to copying
and other uses, especially by the government.

Outside of the passive patients who do
not want education, but just to see the doctor and get his advice,
patients are changing and wanting education to help them manage what
may be wrong, how to keep their health, and improve it. Yes,
patients are becoming more proactive and many want to be more
participatory in their care. What is discouraging is only about 40%
sign up for access to patient portals for secure messaging with their
healthcare providers. I have to wonder if the physicians are
discouraging this or if more will, once 2014 is here. This shows
that there is much to be done between now and 2014.

Since legislating these changes and
offering financial incentives is not obtaining the desired results,
will penalties become necessary? Hopefully, training of new
physicians and retraining of established physicians in communication
skills and interpersonal relationships will be a good start. Those
into participatory medicine believe that the message needs to be
convincing for physicians to practice medicine the right way.

There is also something to be said for
training patients and making them desire to be participatory in their
medical care. At the very least, they should become proactive in
their care and then as they gain confidence may transition to
participatory medicine. Currently, many patients are afraid of what
doctors can do against proactive patients. Are these patients
justified in their concern? Some need to be because of the attitude
of their doctor and some just don't care as they have already
reported their doctor for not providing meaningful use. Until 2014,
there is a lot to learn by both sides.

About Me

I am enjoying life, despite diabetes type 2. I am retired and enjoying the time I have for writing and photography. I was diagnosed with type 2 on Oct 2003, on oral meds for 4 months and they were doing nothing to really improve my daily readings. By cutting my carbohydrates I received the most improvement, but still not enough. Then I requested insulin, even though I did not like the thought of needles. That brought about the biggest change and A1c's in the lower 6's and upper 5's. Now I am working at maintaining them under 6.0 and hopefully nearer 5.5.